Banning guns for mentally ill not so simple

Macomb County’s top mental health official is warning that any attempt by Congress to restrict gun ownership for the mentally disturbed could face challenges due to patient privacy rights and an unhealthy willingness by the public to stigmatize those with mental health problems.

John Kinch, executive director of the county Community Mental Health Services Department, said President Obama is pursuing “common sense approaches” to the link between mental illness and gun crimes. But any effort to ban firearms possession for those with a history of mental health problems will face strong opposition from psychiatrists, therapists and patients.

“There will be some people who will say, what right does the government have to look at my medical records? It … is a privacy issue,” said Kinch, who took over as the county’s mental health director in March 2010.

Steve Gold, director of the county Health and Community Services Department, agreed. Legislation designed to force therapists to surrender information on their clients’ association with guns would likely spur lawsuits, Gold said. In addition, he said gun control advocates should accept the fact that many people with mental health issues are responsible gun owners who like to hunt and engage in target shooting as a sport.

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The National Rifle Association, in their attempt to thwart Obama’s call for a ban on military-style weapons and high-capacity gun magazines, has focused on substantially upgrading the nation’s mental health system so the “deranged” will not gain access to firearms.

But Gold and Kinch caution that a therapist or psychiatrist cannot report to authorities an emotionally disturbed patient who expresses a fascination or obsession with guns. The reporting requirements are limited to instances when a patient makes threats against a particular individual.

In addition, the existing background checks for gun purchases or those seeking a concealed weapons permit are very narrow, largely focusing on those with a psychiatric history. Yet, even that cautious standard could block someone who experienced mental health issues years ago from acquiring a weapon for protection.

The Obama administration said it will strengthen the background check system by addressing legal barriers that keep some mental health records out of the national database. Few details were offered.

Obama’s extensive plan to reduce gun violence calls for the formulation of federal rules requiring insurance companies to cover mental health services on an equal plain with medical services, a plan that has been languishing since 2008. Currently, Michigan is one of six states that do not require mental health parity.

Finalizing the parity rules is an initiative that Senate Democrats have called for in connection with a comprehensive legislative package to reduce gun violence.

The 23 executive orders and actions signed by Obama on Wednesday include a mandated effort to alert those in the medical field of the many benefits covered under Medicaid for those in poverty who need mental health treatment – now and in the near future, when the Obamacare reforms call for an expansion of the program.

The increase in family eligibility from 100 percent of the poverty line to 133 percent, Kinch said, could add 50,000 to 60,000 Macomb residents to the Medicaid rolls. He hopes to engage in community outreach, based on the fact that half of the poor children eligible for Medicaid are not enrolled.

In treatment, Kinch said the psychiatric community is careful to ask mental health “consumers” about violent behavior and deadly weapons they possess only when those questions are pertinent. More often, the caregiver’s “risk assessments” focus on substance abuse, medical problems such as hypertension and diabetes, willingness to comply with a prescription medication regimen, risky behaviors, and “impulsivity.”

“Citizens with mental illness are no more prone to violence then those citizens without having mental illness,” he said.

The White House plan also calls for bolstering access to mental health services in schools and encouraging teachers to intervene early when they believe a student needs counseling.

“We know that the vast majority of Americans with a mental illness are not violent, but we also know that more than 60 percent of people who experience mental illness do not receive treatment and that crisis situations can develop without proper treatment,” Health and Human Services Secretary Kathleen Sebelius said in a statement.

Sebelius and Education Secretary Arnie Duncan will initiate a “national dialogue” on mental health to encourage more people to seek treatment.

Kinch said the greatest challenge – and the most impactful potential result – is eliminating the stigma associated with mental illness that discourages people from seeking treatment and parents from securing help for a disturbed child or teen.

The mental health chief said: “National dialogue needs to be sensitive to mental health consumers and conditions, in so much as the dialogue holds consumers with mental health conditions in a positive regard, similarly to consumers who are physically ill and are in need of support, treatment, understanding, empathy (and) compassion.”